Enrollment options and deadlines

What you need to know about: Enrollment options and deadlines

I’m currently in GHI Senior Care. Can I continue in that plan?

GHI Senior Care will no longer be offered by the NYC Health Benefit Program as of Sept. 1, 2023. You will be automatically enrolled in the Aetna Medicare Advantage PPO plan as of Sept. 1, 2023, and you will switch to the Aetna Medicare Rx administered by SilverScript on Jan. 1, 2024. If you live in New York City or the surrounding counties, you also have the option of opting out of the Aetna plan and switching to the HIP VIP Premier Medicare HMO instead.

How does the Aetna Medicare Advantage PPO plan compare to Senior Care now?

Most city Medicare-eligible retirees are enrolled in the GHI Senior Care plan which supplements traditional Medicare; the Aetna Medicare Advantage PPO plan is a Part C plan. This is an all-in-one plan, which also simplifies your health care. The Aetna Medicare Advantage PPO plan administers both your Medicare Parts A & B. One ID card is all you need, replacing your three ID cards: traditional Medicare, GHI and Empire BlueCross/Blue Shield Hospital ID cards.

You also have additional benefits with the Aetna Medicare Advantage PPO plan that you don’t currently receive under traditional Medicare. See the Senior Care vs. Aetna PPO comparison chart for more details.

How do I enroll in the Aetna Medicare Advantage PPO plan? Will I be enrolled automatically?

If you are a retiree covered by a New York City Medicare health plan, you will be automatically enrolled in the Aetna Medicare Advantage PPO plan on Sept. 1, 2023. You don’t have to do anything. However, you must already be enrolled in Medicare Part A, Medicare Part B and continue to pay your Medicare Part B premiums.

What will happen with procedures or medical services already in process or which are scheduled?

Aetna will send out a Continuity of Care form to all members to allow retirees to notify Aetna of any services they are receiving for continuity’s sake, and Aetna will honor services that are ongoing. To help manage your ongoing care, during the implementation of the new plan, you will receive information on how to contact Aetna, so a nurse case manager can be assigned to answer all your questions and assist you during this transition.

What if I or my spouse is not eligible for Medicare, or under age 65?

Medicare-eligible members will automatically be enrolled into the Aetna Medicare Advantage PPO plan and the non-Medicare member or dependent will remain in the GHI/EBCBS CBP plan, both at $0 cost to the retiree. Eligible dependents of HIP VIP members who are under age 65 will remain in the HIP HMO.

What if I am already enrolled in HIP VIP and want to remain in that plan?

The HIP VIP Premier Medicare Plan HMO will continue to exist after Sept. 1. No action is needed. You will remain in the HIP VIP Premier Plan if you live in New York City, Nassau, Suffolk, Rockland, Orange, or Westchester counties. HIP VIP will be premium-free but, as with the Aetna MA plan, there is a separate cost associated with the Emblem HIP VIP prescription drug rider, as there is today with the Emblem Senior Care drug rider. 

I am currently enrolled in the HIP VIP Premier Medicare HMO, and I want to change to the new Aetna Medicare Advantage PPO plan. What do I need to do?

Action is needed before the opt-out period ends on June 30. You will need to enroll in the Aetna Medicare Advantage PPO plan by filling out the city Office of Labor Relations’ Retiree Special Enrollment/Waiver Form and checking off box #1. Your current drug rider will transfer over to the Aetna Medicare drug rider on Sept. 1, 2023, the same day you move to the new plan. See a comparison of benefits between Aetna Medicare Advantage PPO, GHI Senior Care and HIP VIP. 

I am currently enrolled in GHI Senior Care (along with traditional Medicare) with the drug rider. I live in New York City or the surrounding counties and want to switch to the HIP VIP Premier Medicare HMO. What do I need to do?

Action is needed before the opt-out period ends on June 30. You will need to opt out of the Aetna Medicare Advantage PPO: Call Aetna at 855-648-0389 or go to the Aetna website at CONY.AetnaMedicare.com and click on “Opting out online.” No further steps are necessary after you opt out of Aetna coverage. The city Office of Labor Relations will then automatically enroll you in HIP VIP as of Sept. 1, 2023, and your current drug rider will transfer over to HIP VIP at that time. Please note: You can only switch to the HIP VIP plan if you live in one of the five New York City boroughs or Nassau, Suffolk, Westchester, Rockland or Orange counties. City retirees who live outside that region are not eligible for this plan.

I am enrolled in the current Aetna Medicare Plan (PPO) for retirees. What do I need to do?

No action is needed. You will automatically be enrolled in the new Aetna Medicare Advantage PPO plan as of Sept. 1, 2023.

I am currently enrolled in one of the other city-provided Medicare retiree health care plans (e.g., UnitedHealthCare Group Medicare Advantage Plan, Empire BlueCross BlueShield, Cigna Medicare and Humana Gold Plus). What do I need to do?

No action is needed. These plans will no longer be offered by the NYC Health Benefit Program as of Sept. 1, 2023. You will be automatically enrolled in the Aetna Medicare Advantage PPO plan as of Sept. 1, 2023. If you currently have a drug rider with one of these plans, it will automatically be switched to the Aetna Medicare Rx administered by SilverScript on Sept. 1, 2023. Please call the UFT Welfare Fund if you have questions regarding your prescription coverage. Please note: If you live in New York City or the surrounding counties, you also have the option of opting out of the Aetna plan and switching to the HIP VIP Premier Medicare HMO instead.

Will I be able to transfer to another city health plan during the next open enrollment period in the fall of 2023?

Yes. You can transfer between the Aetna Medicare Advantage PPO plan and the HIP VIP during this period if you live in New York City, Nassau, Suffolk, Rockland, Orange, or Westchester counties. Please note, you may transfer out of one city plan and into another city plan or return from a non-city plan to a city plan at any point in time by using the once per lifetime transfer option that the city offers.

What other options do I have for coverage if I don’t want the new Aetna plan? Can I opt-out?

You can opt out of the Aetna Medicare Advantage PPO plan during the opt-out period, which is between May 1, 2023 and June 30, 2023, and enroll in the HIP VIP plan if you live in New York City, Nassau, Suffolk, Rockland, Orange, or Westchester counties. You can also choose to move to traditional Medicare coverage and pay directly for a private Medigap or Medicare Advantage plan on your own; however, you will lose city reimbursements for Medicare Part B and IRMAA as you will no longer be enrolled in a city-sponsored health plan.

I am currently enrolled in GHI Senior Care. I do not want to enroll in either the Aetna Medicare Advantage PPO plan or the HIP VIP Premier Medicare HMO. I want to retain traditional Medicare Parts A and B and buy my own private supplemental plan. What do I need to do?

Action is needed before June 30. The choice you are making is considered “waiving” or “terminating” New York City Health Benefits coverage. To waive/terminate your city health benefits coverage, you will need to fill out the city Office of Labor Relations’ Retiree Special Enrollment/Waiver Form and check off box #4. Please note: When you choose to waive/terminate your city health benefits coverage, you are removing yourself and your dependents from all city health insurance coverage. You will no longer be eligible for the city’s annual Medicare Part B and IRMAA reimbursements (if applicable). If you choose this option, your current health care coverage would end on Aug. 31, and we strongly suggest that you make sure that any new supplemental plan that you purchase starts on Sept. 1. If you choose to buy your own insurance plan, we advise you also to consider buying a Medicare Part D plan for prescription drug coverage.

If I opt out of city health care coverage and move to a traditional Medicare plan, will my dependents be able to continue their coverage through the city?

No. If you opt out of city health care coverage, any of your dependents also enrolled in a city plan would no longer continue to receive city health coverage as well.

What steps are being taken to ensure continuous coverage for members who decide to opt out?

Should a member opt out of the Aetna Medicare Advantage PPO plan, they have the other remaining option of HIP VIP where coverage will be monitored and continuous. Should a member opt out to pursue a private Medigap plan, their traditional Medicare coverage remains active with the Centers for Medicare, but it only covers approximately 80% of medical costs. The additional 20% provided by a private Medigap plan will be contingent upon them identifying and enrolling with that private plan.

Can retirees join a Medigap plan at any time? Are there limitations?

Medigap policies vary from state-to-state. New York, Connecticut, Massachusetts and Maine have “guaranteed issue” protections that allow retirees to purchase Medigap plans at any time, for any reason, without any pre-existing condition exclusions. In other states, those protections are not as broad and limitations may be imposed.

Federal law allows for a “Medicare Advantage Trial Right” period which allows Medicare-eligible retirees who have never been enrolled in a Medicare Advantage plan before, and are currently enrolled in original Medicare with a Medigap policy, to switch to a Medicare Advantage plan on a 12 month trial basis, for one time only. If a retiree decides to go back to original Medicare with a Medigap policy during that 12 month period, they could do so with guaranteed issue rights.

Once city retirees are enrolled in the Aetna Medicare Advantage PPO, and it is their first time in any Medicare Advantage plan, if they chose to switch to original Medicare and purchase an Aetna Medigap plan instead, Aetna would honor their guaranteed issue rights if the switch happened within 12 months after their Aetna Medicare Advantage PPO enrollment.

If I opt out of the Aetna Medicare Advantage PPO plan but later change my mind and want to re-enroll in the city’s health plan, may I do so?

Yes, under three scenarios:

1. During the city’s next annual open enrollment period (which will be in Nov. 2023), you can opt-in to the Aetna Medicare Advantage PPO plan and coverage would then be effective as of the start of the following calendar year.
2. The city offers a once in a lifetime opportunity to make changes outside of the usual annual transfer period. If you have not exercised this benefit in the past, the city will allow you to come back outside of the transfer period.
3. Through a qualifying event, such as existing coverage being terminated due to circumstances outside of your control.

I already subscribe to a Medicare Advantage plan. Can I keep that plan and opt-out of the new Aetna plan?

Yes, if you want to keep your enrollment in another Medicare Advantage plan not sponsored by the city, you must opt-out of the Aetna Medicare Advantage PPO. However, if you do not remain in a city health plan, you will not be able to have your Medicare B premium reimbursed by the city.

The Centers for Medicare & Medicaid Services (CMS) does not allow enrollment in more than one Medicare Advantage (Part C) plan at a time and will count your last enrollment as the plan you have selected. Otherwise, if you are currently enrolled in any other Medicare Advantage plan such as a plan purchased from the open market, through a former employer, or as a dependent of your spouse or domestic partner, the Aetna Medicare Advantage PPO plan will automatically disenroll you from the other Medicare Advantage (Part C) plan in which you are enrolled.